Blood use in sub‐Saharan Africa: a systematic review of current data

Background: Data on the use of blood products in sub-Saharan Africa (SSA) are scarce. A systematic review of published data on blood utilization according to diagnosis in SSA was performed. Study design and methods: Studies published from January 2000 to June 2018 were searched in PubMed, Embase and African Index Medicus. Data were extracted and synthesized. The proportion of blood products used for different diagnostic categories is presented. Results: 37 studies representing 159,746 transfusions to 96,690 patients from 14 countries in SSA were included. Data from six of 37 studies were pooled to determine blood product use according to diagnosis. The primary diagnostic categories were pediatric malaria (20%), sickle cell anemia [SCA] (18%), obstetric hemorrhage (16%), and other causes of bleeding (16%). About 8%, 6% and 2% of products were used for other infections, cancer treatment, and surgery respectively. Overall, 58.5% of the products transfused were red blood cells, 31.7 % whole blood, 7.2% fresh frozen plasma, and 2.6% as platelets. Estimated blood product use per population in SSA was 5.3 transfusions per 1000 people, compared with 52 and 34 per thousand for Australia and United States respectively. Conclusion: This study provides a systematic attempt to quantify blood utilization for SSA. Blood products in SSA are used primarily for pediatric malaria, SCA, obstetric hemorrhage and other causes of bleeding. Studies such as this represent an important early step towards improving hemovigilance in SSA

The impact of tubal ectopic pregnancy in Papua New Guinea - a retrospective case review

BACKGROUND: Ectopic pregnancy (EP) is an important cause of morbidity and mortality amongst women of reproductive age. Tubal EP is well described in industrialised countries, but less is known about its impact in low-resource countries, in particular in the South Pacific Region. METHODS: We undertook a retrospective review of women with tubal EP treated at a provincial referral hospital in coastal Papua New Guinea over a period of 56 months. Demographic and clinical variables were obtained from patients’ medical records and analysed. The institutional rate of tubal EP was calculated, and diagnosis and management reviewed. Potential risk factors for tubal EP were identified, and delays contributing to increased morbidity described. RESULTS: A total of 73 women had tubal EP. The institutional rate of tubal EP over the study period was 6.3 per 1,000 deliveries. There were no maternal deaths due to EP. The mean age of women was 31.5+/−5.7 years, 85% were parous, 67% were rural dwellers and 62% had a history of sub-fertility. The most commonly used diagnostic aid was culdocentesis. One third of women had clinical evidence of shock on arrival. All women with tubal EP were managed by open salpingectomy. Tubal rupture was confirmed for 48% of patients and was more common amongst rural dwellers. Forty-three percent of women had macroscopic evidence of pelvic infection. Two-thirds of patients received blood transfusions, and post-operative recovery lasted six days on average. Late presentation, lack of clinical suspicion, and delays with receiving appropriate treatments were observed. CONCLUSIONS: Tubal EP is a common gynaecological emergency in a referral hospital in coastal PNG, and causes significant morbidity, in particular amongst women residing in rural areas. Sexually transmitted infections are likely to represent the most important risk factor for tubal EP in PNG. Interventions to reduce the morbidity due to tubal EP include the prevention, detection and treatment of sexually transmitted infections, identification and reduction of barriers to prompt presentation, increasing health workers’ awareness of ectopic pregnancy, providing pregnancy test kits to rural health centres, and strengthening hospital blood transfusion services, including facilities for autotransfusion

Entrance skin dose on patients undergoing X-ray examinations at Yaba, Lagos State, Nigeria

survey was conducted on the Entrance Skin Dose (ESD) in patients undergoing X-ray examinations [Skull Postero-Anterior (PA), Skull Lateral (LAT), Chest Postero-Anterior (PA), Chest Lateral (LAT), Abdomen Antero-Posterior (AP) and Pelvis Antero-Posterior (AP)] in five hospitals/Xraycentres in Yaba, Lagos State, Nigeria. A total of 258 patients were included in the survey. ESD data of each patient was generated using technical parameters and a Program and Effective Dose was then computed. Results showed that the mean ESD values obtained from this work; 2.41, 1.56, 3.48 and 3.04 mGy for Skull PA, Skull LAT, Abdomen AP and Pelvis AP examinations respectively were lower than the international reference dose values. However, the mean ESD values for Chest PA and Chest LAT examinations obtained from this study, which were 1.07 and 2.28 mGy respectively, were higher than the international reference dose values. The mean Effective Dose value obtained from this study for Chest PA examination was higher than the National Radiological Protection Board (NRPB) and Greek values.Keywords: Entrance Skin Dose, X-ray examination, ionizing radiation, reference dose value

Indoor radon survey in a university campus of Nigeria

CR-39 tracketch detectors were used for the measurement of 222Rn concentration in 24 offices in Nigeria’s oldest university campus in order to estimate the effective dose to the occupants from 222Rn and its progeny. The dosimetric measurements were made over a period of 3 months. Questionnaires were distributed and analyzed. The radon concentration ranged from 157 to 495 Bq/m3, with an arithmetic mean and standard deviation of 293.3 and 79.6 Bq/ m3, respectively. The effective dose to the workers was estimated and this varied from 0.99 to 3.12 mSv/ y, with a mean of 1.85 mSv/y. The radon concentrations were found to be within the reference levels of ICRP